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Why they just won't do what you tell them: client compliance (Proceedings)

One of my dear friends and colleagues – a veterinary cardiologist – often teases me that behavior can't really be that hard. She thinks that a behaviorist's work rarely exceeds the advice to add another litter box. While it's true that implanting a pace maker is more impressive than 'adding a litter box', I like to emphasize that I'm able to keep more pets in their families and alive when we compare our case outcomes. This hasn't always been the case. Even if I was sure that I had the correct diagnosis and set up a well-designed treatment plan, including elaborate behavior modification programs, medications, and management recommendations, cases often failed to improve and many of my patients we surrendered, rehomed or euthanized. What went wrong?

I did what I was trained to do in vet school and during my specialty training. I gathered the information needed, came to a diagnosis, recommended what I thought would best alter the problem, and sent the client home with explanations of the causes, behavior modification programs, management recommendations, and medications, assuming that they would implement the changes immediately.

But we all know that client compliance is an issue. Some owners fail to give antibiotics for the recommended number of days. Others may buy an expensive exclusion diet and still continue to feed treats. And few clients will really add another litter box (in the few cases in which I actually recommend it), especially if I ask to place the open box on the main floor of the house instead of the basement. More commonly, I see clients discontinuing abruptly the urine marking cat's prescription for fluoxetine despite my warning that this will lead to a relapse. Why?

We fail to develop treatment plans with the client. Instead we unilaterally create a tool and expect that it 'fits'. But because we are not trained to listen, to take into consideration a client's circumstances, their needs, strengths and limitations, the plan often won't work out. Clients are overwhelmed, not convinced, and provided with information that may not answer their questions or meet their needs.

"Dead end' communication takes place everywhere every day. To communicate effectively, it is essential to assess the client's motivation, her environmental system, physical environment, values, strengths and limitations. Based on these factors, the provider and client develop jointly (!) goals and formulate a 'contract'. This process requires that we explore and understand the client's reality and accept his or her 'framework' as it sets the stage for our work and the development of a plan that is completed jointly.

In many cases, we ask our clients to change their ways, adapt new strategies, and adjust their interactions with their pet. Clients are at different stages of readiness to make changes. Interactions must be non-judgmental, non-confrontational and non-adversarial. If a goal is set jointly, the client is part of the solution, is emotionally invested, and bought into the plan based on explicit and measurable terms.

Strategies focus on client's awareness of the potential causes, the resulting problems, consequences experienced, and risks faced as a result of the behavior in question. It is imperative to help clients think differently about their behavior as well as the behavior of their pet and ultimately to consider what might be gained through change.